Antimicrobial Prophylaxis for Urologic Procedures in Paediatric Patients: A RAND/UCLA Appropriateness Method Consensus Study in Italy

Abstract

The main aim of surgical antimicrobial prophylaxis (SAP) in urologic procedures is to prevent bacteraemia, surgical site infections (SSIs), and postoperative urinary tract infections (ppUTIs). Guidelines for SAP in paediatric urology are lacking. Only some aspects of this complex topic have been studied, and the use of antibiotic prophylaxis prior to surgical procedures seems to be more often linked to institutional schools of thought or experts’ opinions than to rules dictated by studies demonstrating the most correct and preferred management. Therefore, the aim of this Consensus document realized using the RAND/UCLA appropriateness method is to provide clinicians with a series of recommendations on SAP for the prevention of bacteraemia, SSIs, and ppUTIs after urologic imaging and surgical procedures in paediatric patients. Despite the few available studies, experts agree on some basilar concepts related to SAP for urologic procedures in paediatric patients. Before any urological procedure is conducted, UTI must be excluded. Clean procedures do not require SAP, with the exception of prosthetic device implantation and groin and perineal incisions where the SSI risk may be increased. In contrast, SAP is needed in clean-contaminated procedures. Studies have also suggested the safety of eliminating SAP in paediatric hernia repair and orchiopexy. To limit the emergence of resistance, every effort to reduce and rationalize antibiotic consumption for SAP must be made. Increased use of antibiotic stewardship can be greatly effective in this regard.

Management of Pediatric Urinary Tract Infections: A Delphi Study

“…Rates were higher in patients with preexisting urologic abnormalities, especially high-grade reflux [ 90 ]. Considering that Gram-negative bacilli and enterococci are the most likely pathogens, the combination trimethoprim/sulfamethoxazole (2 mg/kg of trimethoprim component orally in patients > 6 weeks of age) or amoxicillin/clavulanic acid (50 mg/kg of the amoxicillin component orally) or gentamicin (2.5 mg/kg intravenous/intramuscular) immediately prior to intervention can be recommended [ 91 , 92 ].…”

Current Status and Prospects of Pediatric Stone Disease: A Bibliometric and Visualization Study

“…It is the most invasive option, requiring general anesthesia to insert a needle into the kidney's collecting system, expand the access channel, and use nephroscopes for stone removal [40]. Preoperative management includes evaluating and treating urinary tract infections, with antibiotics administered perioperatively [41]. The American Urological Association suggests PCNL for kidney stone burdens greater than 20 mm, citing a stone clearance rate of over 90% [33].…”

Prevention of Surgical Site Infections in Neonates and Children: Non-Pharmacological Measures of Prevention

“…This document describes the current knowledge on risk factors for SSIs in neonates and children undergoing surgery and has the purpose of providing guidance to health care professionals for the prevention of SSIs in this population. Our aim is to consider the possible non-pharmacological measures that can be adopted to prevent SSIs, except the use of antibiotics, for which we refer to the specific papers of the Peri-Operative Prophylaxis in Neonatal and Paediatric Age (POP-NeoPed) Study Group [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. To our knowledge, this is the first study to provide recommendations based on a careful review of the available scientific evidence for the non-pharmacological prevention of SSIs in neonates and children.…”